Angiology最新文献

Atherosclerosis often starts in childhood, tracking to adulthood. In children, early vascular disease can be detected as arterial stiffness. Carotid-femoral pulse wave velocity is considered the non-invasive gold standard method for measuring arterial stiffness and widely accepted for use in children. We define pulse wave velocity (PWV) reference values for African children, in a cohort of children and adolescents living in Cape Town, South Africa, using the oscillometric Vicorder device, and considering the anatomical pathway in growing children. Three hundred and twenty four children (6-16 years old) were followed annually at Tygerberg Hospital, from March 2014 to March 2020, yielding 959 longitudinal PWV measurements. Centile curves for males and females by age and height were constructed using the Lamda-Mu-Sigma (LMS) method. Our study demonstrates that African children have a relatively flat PWV throughout childhood and early adolescence, from 7 to 14 years of age, and between 120 and 170 cm standing height. These gender-specific percentiles for age and height will allow accurate surveillance of arterial elasticity in African children over time. The identification of children at high risk is important given the long-term health implications and the effectiveness of early intervention to prevent progression to cardiovascular disease.

This meta-analysis evaluates outcomes in patients undergoing bioprosthetic aortic valve replacement (bAVR), comparing different antithrombotic strategies. We conducted a systematic search through May 2024. A standard meta-analysis compared outcomes between patients who received anticoagulation therapy (AC) and those who did not. Therapeutic categories were subdivided into four groups: AC alone, AC with antiplatelet therapy (AP), AP alone, and no antithrombotic therapy. A network meta-analysis was performed for these categories. The review included 16 studies, comprising a total of 59,054 patients. There was no significant difference in all-cause mortality rates (HR: hazard ratio [95% CI: confidence interval] = 0.98 [0.77-1.25], P = .88) or thromboembolic events (HR [95% CI] = 0.91 [0.65-1.28], P = .60) between patients with and without AC. However, bleeding events were significantly higher in patients receiving AC (HR [95% CI] = 1.55 [1.20-2.00], P < .01). Network meta-analysis showed that AP alone was associated with lower mortality rates compared with other therapeutic categories. Additionally, AP alone was associated with fewer bleeding events compared with AC alone and AC with AP. This meta-analysis suggests that AP alone in patients undergoing bAVR is associated with superior outcomes compared with other antithrombotic strategies.

Ankle brachial index (ABI) can be unreliable in patients with non-compressible vessels. Our aim is to determine the feasibility of toe brachial index (TBI) and reporting criteria in a large population. We evaluated Doppler waveforms and segmental pressures in 26,719 limbs. TBI was obtained in 92.7%, mean TBI = 0.61 ± 0.25. TBI was obtained in 82%of limbs with unobtainable ABI. In hemodynamically normal subgroup (defined as those with normal ankle-brachial indices at rest and after exercise) the mean TBI was 0.84 ± 0.14. In severe PAD subgroup (defined as ABI < 0.5 and monophasic waveforms) the mean TBI was 0.16 ± 0.12. Limbs with a diagnosis of a PAD (ABI ≤ 0.9) had a TBI <0.8 in 99.5% of the cases, and <0.6 in 90% of the cases. A TBI of 0.8 had a negative predictive value for PAD of 0.99. A TBI cutoff of 0.6 had a positive predictive value for PAD of 0.95. Based on these results we propose defining normal TBI above 0.8, borderline between 0.8 and 0.61, abnormal TBI ≤ 0.6 and severe PAD as TBI ≤ 0.2. In conclusion TBI can be reliably measured in patients with PAD and offer valuable information when diagnosing PAD. We present our diagnostic criteria based on clinical data.

Contrast-induced nephropathy (CIN) poses a significant risk following primary percutaneous coronary intervention (pPCI) in patients with ST-Elevation Myocardial Infarction (STEMI). Magnesium (Mg²⁺) deficiency has been associated with renal dysfunction and cardiovascular diseases, yet its role in CIN development remains unclear. This study represents the first investigation exploring the relationship between Mg²⁺ levels and CIN in this context.We conducted a retrospective study involving 2306 consecutive STEMI patients undergoing pPCI. Serum Mg²⁺ levels were measured on admission. Logistic regression and Receiver Operating Characteristic (ROC) analysis were employed to assess the association between Mg²⁺ levels and CIN development. Of the enrolled patients, 691 (30%) developed CIN post-pPCI. Mg²⁺ levels were significantly lower in the CIN group (P < .001). Multivariate analysis identified Mg²⁺ <2.03 mg/dL, age >68 years, left ventricular Ejection Fraction (EF) <49%, and post-procedure Thrombolysis In Myocardial Infarction (TIMI) flow grade <2 as independent predictors of CIN. ROC analysis revealed an Mg²⁺ cutoff of 2.03 mg/dL, Area Under the Curve (AUC): 0.711, sensitivity: 69%, specificity: 68%). Our study demonstrates a significant correlation between low Mg²⁺ levels and CIN in STEMI patients undergoing pPCI, highlighting Mg²⁺ <2.03 mg/dL as an independent risk factor for CIN.

Breast cancer is the most common malignancy among women. While advances in detection and treatment have improved survival, breast cancer survivors face an increased risk of cardiovascular disease. However, limited data exist on cardiac outcomes after ST-elevation myocardial infarction (STEMI) in this population. This retrospective cohort study analyzed the National Inpatient Sample (NIS) database (2016-2021). Adult women hospitalized with STEMI were categorized as breast cancer survivors or without a history of breast cancer. The primary outcome was in-hospital mortality, with multivariable logistic regression used to adjust for confounders. A total of 369,070 adult females were included (breast cancer survivors, n = 13,890; without breast cancer, n = 355,180). Breast cancer survivors were older with more cardiovascular comorbidities. After adjustment, breast cancer survivors had lower odds of in-hospital mortality (adjusted odds ratio [aOR] 0.82, 95% CI 0.72-0.93), cardiogenic shock (aOR 0.88, 95% CI 0.77-0.99), and acute kidney injury (aOR 0.85, 95% CI 0.76-0.95). Breast cancer survivors hospitalized for STEMI had lower in-hospital mortality and complications, compared with those without breast cancer. These hypothesis-generating findings suggest that advances in oncology and cardiovascular care may contribute to improved outcomes.

We aimed to investigate the association between systemic inflammation and the left ventricular global function index (LVGFI) and evaluate the diagnostic performance of LVGFI for MACEs across the acute coronary syndrome (ACS) spectrum. A total of 1697 patients (794 with ST-segment elevation myocardial infarction [STEMI] and 903 with non-STEMI [NSTEMI]) were evaluated. The LVGFI was calculated using echocardiography. Inflammatory status was assessed with C-reactive protein (CRP) and the systemic immune inflammation index (SII). MACEs were defined as non-fatal re-infarction, repeated revascularization of the target vessel, and all-cause mortality at a 3-year follow-up. While the STEMI group exhibited lower LVGFI values compared with the NSTEMI group (P < .001), it had a higher SII level (P < .001) and CRP level (P = .021). The association between higher LVGFI quartiles and lower levels of systemic inflammation was more pronounced in the STEMI group. The threshold value of LVGFI to predict MACEs was <21.8% (Sensitivity = 79.2%, Specificity = 68.7%) for STEMI, while it was <25.4% (Sensitivity = 77.4%, Specificity = 70.8%) for NSTEMI. Considering both the inflammatory status and ACS spectrum when evaluating LVGFI could provide a more comprehensive assessment of cardiac function and prognosis in ACS patients.

Severe left main coronary artery (LMCA) lesions (≥50% stenosis) portend a poor prognosis and require urgent revascularization. In this study, we identified the incidence and clinical predictors of severe LMCA stenosis in patients with chronic coronary syndrome (CCS) who had undergone coronary angiography for the first time. Using a nationwide database registry, all the patients with CCS who had undergone coronary angiography were included. Patients were classified based on having severe LMCA stenosis and they were compared based on the recommended therapeutic strategy after angiography. A multivariable binary logistic regression model was developed to identify the potential predictors of a severe LMCA lesion. Among 40,161 patients with CCS, a severe LMCA lesion was detected in a total of 1556 participants (3.87% [3.69; 6.07]). The multivariable logistic regression identified age (odds ratio [OR]: 1.04 [1.03;1.04]), male gender (OR:2.56 [2.28; 2.89]), dyslipidemia (OR:1.19 [1.06; 1.34]), and peripheral arterial disease (PAD) (OR:3.68 [1.06;12.83]) as predictors of a severe LMCA stenosis. Approximately 4% of patients with newly diagnosed CCS may suffer from severe LMCA disease. Age, male gender, dyslipidemia, and PAD are among the predicting factors of a severe LMCA stenosis and can be utilized in risk stratification of patients with CCS at greater risk of severe LMCA stenosis.